Tag Archives: cognitive therapy

Stoicism and Cognitive Behavioral Therapy

Stoicism and Cognitive Behavioral Therapy

Stoic Fatalism, Determinism, and Acceptance

Stoic Fatalism, Determinism & Acceptance

The Practice of Cognitive-Behavioural TherapyExcerpt from The Philosophy of Cognitive-Behavioural Therapy (CBT): Stoic Philosophy as Rational & Cognitive Psychotherapy (2010) by Donald J. Robertson.

Whatever sorrow the fate of the Gods may here send us
Bear, whatever may strike you, with patience unmurmuring;
To relieve it, so far as you can, is permitted,
But reflect that not much misfortune has Fate given to the good. – The Golden Verses of Pythagoras

Paul Dubois was perhaps the first modern “rational” psychotherapist to explicitly argue that emotional problems could be made worse by certain, often unspoken, philosophical assumptions about freewill and determinism which prevail in modern society.

Patience towards unavoidable events, depending neither upon us nor upon others, is synonymous with fatalism; it is a virtue, and it is the only stand to take in face of the inevitable. […] The idea of necessity is enough for the philosopher. We are all in the same situation towards things as they are, and towards things that we cannot change. The advantage will always lie with him who, for some reason or other, knows how to resign himself tranquilly. (Dubois, 1909, pp. 240-241)

This notion is equally prominent in Stoic literature. In the Handbook, Epictetus boldly asserts that if we merely train ourselves in wishing things to happen as they do, instead of expecting them to happen as we wish, then our lives will go smoothly (Enchiridion, 8). In the Discourses, he actually defines the practice of philosophy in terms of such acceptance, when he writes, ‘Being educated [in Stoic philosophy] is precisely learning to will each thing just as it happens’ (Discourses, 1.12.15). In an extant fragment from his other teachings, he says that the man who refuses to accept his fortune is a “layman in the art of life” (Fragment 2).

The conceptual and metaphysical problem of freewill has been a central theoretical concern throughout the entire history of Western philosophy. However, Dubois, the Stoics, and others, have seen confusion over precisely this issue as a central psychotherapeutic concern. Dubois dedicates a whole chapter of his textbook on psychotherapy to the issue of determinism in which he asserts, ‘My convictions on this subject have been of such help to me in the practise of psychotherapy that I can not pass this question by in silence’ (Dubois, 1904, p. 47). However, in modern society we take certain metaphysical views regarding freewill for granted, and seldom examine whether they are well-founded, or even logically consistent.

There are some conclusions which we easily arrive at by using the most elementary logic, and which we dare not express. They seem to be in such flagrant contradiction to public opinion that we fear we should be stoned, morally speaking, and we prudently keep our light under a bushel. The problem of liberty is one of those noli me tangere [“do not touch me”] questions.

If you submit it to a single individual in a theoretical discussion, in the absence of all elementary passion, he will have no difficulty in following your syllogisms; he will himself furnish you with arguments in favour of determinism. But address yourself to the masses, or to the individual when he is under the sway of emotion caused by a revolting crime, and you will call forth clamours of indignation, – you will be put under the ban of public opinion. (Dubois, 1904, p. 47)

The philosophical debate concerning “freewill versus determinism” in modern academic philosophy is incredibly complex. Dubois only engages with it at a very superficial level. However, one aspect of the debate can perhaps be made explicit by means of a very crude syllogism of the kind Dubois had in mind.

Most people seem to assume that we generally act on the basis of freewill, which is constrained to varying degrees by obstacles in their environment. So a man is free from extrinsic restrictions or limitations, and therefore completely responsible for his actions, unless he is held at gunpoint, or brainwashed, etc. However, this popular way of looking at things seems to confuse two different concepts of “freedom”, that of freedom from the effects of preceding causal factors, and that of freedom to pursue future goals without obstruction. By contrast, the simple determinist position of Dubois can be outlined as follows,

  1. All physical activity of the brain is wholly determined by antecedent causal factors.
  2. All mental activity is wholly determined by physical activity in the brain.
  3. Therefore, all mental activity is wholly determined by antecedent causal factors.

There are many variations of this argument, exhibiting different degrees of philosophical complexity and sophistication. However, this simple “premise-conclusion” format should at least be sufficient to expose the basic controversy. As Dubois observes, if we accept the physiological basis of the mind, ‘all thought being necessarily bound to the physical or the chemical phenomena of which the brain is the seat’, we are ultimately forced to abandon the metaphysical theory of freewill (Dubois & Gallatin, 1908, p. 9).

Doing so does not logically entail apathy and inertia, as many people falsely assume. Indeed, a man may be causally determined to respond to the perception of universal determinism with a sense of renewed commitment to his ideals, and to vigorous action.

At the exact moment that a man puts forth any volition whatever his action is an effect. It could not either not be or be otherwise. Given the sensory motor state, or the state of the intellect of the subject, it is the product of his real mentality. […] But it is nowhere written that the individual is going to persist henceforward in a downward course, that he is fatally committed to evil. But the fault having been committed, it should now be the time for some educative influence to be brought to bear, to bring together in his soul all the favourable motor tendencies and intellectual incentives, to arouse pity and goodness, or found on reason the sentiment of moral duty. (Dubois, 1904, pp. 55-56)

To a large extent, the defence of freewill has been a central concern of medieval Christian ethics and traditionally depends upon making a sharp metaphysical division between the body and the mind, such that our will can be considered the unfettered activity of a soul which exists independently of the body, a “ghost in the machine”, as Gilbert Ryle famously put it (Ryle, 1949).

However, if we accept the argument for determinism at face value it has radical implications for our attitudes toward ourselves and other people. It forces us to see other people as the product of genetics and environment and therefore acting in a manner which they cannot be “blamed” for in the ordinary sense of the word, i.e., in an absolute, metaphysical sense. We are all, to a large extent, victims of circumstance, insofar as we do what we do with the brains and the upbringing that nature has given us. Dubois puts this quite eloquently,

I know of no idea more fertile in happy suggestion than that which consists in taking people as they are, and admitting at the time when one observes them that they are never otherwise than what they can be.

This idea alone leads us logically to true indulgence, to that which forgives, and, while shutting our eyes to the past, looks forward to the future. When one has succeeded in fixing this enlightening idea in one’s mind, one is no more irritated by the whims of an hysterical patient than by the meanness of a selfish person.

Without doubt one does not attain such healthy stoicism with very great ease, for it is not, we must understand, merely the toleration of the presence of evil, but a stoicism in the presence of the culprit. We react, first of all, under the influence of our sensibility; it is that which determines the first movement, it is that which makes our blood boil and calls forth a noble rage.

But one ought to calm one’s emotion and stop to reflect. This does not mean that we are to sink back into indifference, but, with a better knowledge of the mental mechanism of the will, we can get back to a state of calmness. We see the threads which pull the human puppets, and we can consider the only possible plan of useful action – that of cutting off the possibility of any renewal of wrong deeds, and of sheltering those who might suffer from them, and making the future more certain by the uplifting of the wrong-doer. (Dubois, 1904, p. 56)

In other words, contemplation of determinism, the idea that human actions are definitely caused by a complex network of multiple preceding factors, mitigates our anger toward other people, and leads us closed to a healthy sense of understanding and forgiveness. We are also more enlightened regarding our practical responses and more inclined to reform rather than punish wrongdoers. When Socrates argued in The Republic that the Sage wishes to do good even to his enemies, he meant that the Sage sought to educate and enlighten others, seeing that as their highest good. That harmonious attitude is the polar opposite of the one which seeks revenge through moralising punishment. It leads to a sense of generosity and equanimity, and resolves anger, resentment, and contempt.

The Paradox of Freewill versus Determinism

Like Dubois after them, the Stoics were determinists, who believed that all events in life, including our own actions, are predetermined to happen as they do. However, paradoxically, they were also passionately in favour of increased personal responsibility and belief in one’s freedom to act and make decisions in accord with reason. Hence, Epictetus constantly reminds his students that no matter what happens to them they still have the opportunity to make of life what they will.

Sickness is an impediment to the body, but not to the faculty of choice, unless that faculty itself wishes it to be one. Lameness is an impediment to one’s leg, but not to the faculty of choice. And say the same to yourself with regard to everything that befalls you; for you will find it to be an impediment to something else, but not to yourself. (Enchiridion, 9)

Epictetus himself was famously lame, reputedly after being brutally crippled by his master when enslaved, so these remarks must have carried an extra poignancy, given his obvious physical disability.

To many people this seems confusing and contradictory. How can the Stoics emphasise both freedom and determinism? However, as often proves the case in philosophy, it is not the answer which is confused but the question. The Stoics evidently believe that the concepts of freedom and determinism are compatible.

It is virtually certain that Epictetus’ concept of a free will, far from requiring the will’s freedom from fate (i.e., a completely open future or set of alternative possibilities or choices), presupposes people’s willingness to comply with their predestined allotment. The issue that concerns him is neither the will’s freedom from antecedent causation nor the attribution to persons of a completely open future and indeterminate power of choice. Rather, it is freedom from being constrained by (as distinct from going along with) external contingencies, and freedom from being constrained by the errors and passions consequential on believing that such contingencies must influence or inhibit one’s volition. (Long, 2002, p. 221)

Confusion is caused because of a well-known and long-standing ambiguity in the popular notion of “freewill”. Metaphysical “freedom” refers to the freedom of the soul to act independently of antecedent causal factors. However, by contrast, “freedom” in common parlance merely refers to the ability of something to perform its prescribed function without external impediment or obstruction. A wheel turns freely unless, for instance, it is buckled or stopped by a rock. People act freely unless, for instance, other people restrain them physically or mentally. ‘For he is free for whom all things happen in accordance with his choice, and whom no one can restrain’ (Discourses, 1.12.8).

The great Stoic academic, Chrysippus explained the Stoic theory of freewill and determinism by means of his famous “cylinder analogy”. In this example, it is argued that if we roll a cylinder along the ground, the initial impetus to move is given by someone pushing it, but the direction in which the cylinder moves, in a straight line, is determined by its own shape. The push is an example of what Stoics call an “external cause” coming from without, whereas the shape of the cylinder is the “internal cause” of the direction it takes, its own constitution. External causes impinge upon the human mind through the senses, and through other effects upon the body. However, the constitution, or character, of our mind determines how we will respond, acting as an “internal cause” of our response.

The mind is therefore autonomous to the extent that it can determine the direction in which it acts on the basis of its own character, however, external events impinge upon it and trigger its responses. Our actions are like the movement of the cylinder, insofar as both are due to a combination of “internal” and “external” factors. The cylinder is free to move according to its own nature so long as no further external causes obstruct it.

Whatever happens to you has been waiting to happen since the beginning of time. The twining strands of fate wove both of them together: your own existence and the things that happen to you. (Meditations, 10.5)

In this sense of the word “freedom”, which we should remind ourselves happens to be the normal sense, there is no incompatibility whatsoever with the notion of determinism because there is no reference made to the preceding causes which make the wheel turn, or the person act, in the first place. The cylinder rolls freely, its movement determined by antecedent events.

The notion of being free from preceding causes, by comparison, is a much more unusual and problematic concept. As Skinner argues at length in Beyond Freedom & Dignity, as our scientific understanding advances with regard to human behaviour, the notion that we were somehow exempt from universal determinism is very much eroded (1971, p. 21). He adds, ‘Although people object when a scientific analysis traces their behaviour to external conditions and thus deprives them of credit and the chance to be admired, they seldom object when the same analysis absolves them of blame’ (Skinner, 1971, p. 75).

But what of the inner feeling of freewill? Whatever sensations or impressions we might feel of “effort”, the idea that our actions are free is simply a sign that we are ignorant of their causes.

We do not think enough about the yoke inside, the result of ideas so thoroughly adopted that they seem like our own. That is what Spinoza meant when he said, “Men think themselves free only because they get a clear view of their actions, they do not think of the motives that determined them.” (Dubois, 1909, p. 53)

My freedom toward the future is a different matter and down to my specific circumstances in each situation, i.e., whether I am obstructed by external events or not.

When people are told that things happen because they have been determined by the preceding chain of causes they usually respond, at first, by complaining that there’s no point trying to change anything in that case. The Stoics and other ancient philosophers knew this as the “lazy argument”, and considered an obvious fallacy. The theory of determinism does not hold, as this fallacy requires, that all events are completely determined only by external causes, i.e., that people are completely passive in relation to the world. Rather, it holds that events are co-determined by the interaction of internal and external causes. My actions are part of the causal network, and therefore have an effect upon the things which happen. Nevertheless, accepting those things which are genuinely beyond my control, with philosophical resignation, is a key rational therapeutic strategy, and employed extensively by Stoics in the face of adversity.

Cognitive Distancing in Stoicism

Cognitive Distancing in Stoicism

“Distancing” versus “Disputation” as the central process of Stoic psychotherapy

thought-bubbleCopyright © Donald Robertson, 2013.  All rights reserved.

This article explores whether “distancing” from thoughts/impressions or “disputation” of underlying irrational beliefs is more integral to Stoic therapy.  If it were established that ancient Stoicism employed a focus on “cognitive distancing” strategies that would be important for several reasons.  Distancing is a simpler and more consistent procedure than verbal disputation, so analogies between Stoicism and CBT would be easier to make.  Moreover, large volumes of research now exist on distancing, which suggest that it may be one of the most important mechanisms in psychotherapy, and may serve both a preventative and remedial function.  Some groups of modern researchers also believe that disputation may interfere with distancing, which would be an important consideration for modern Stoics to assimilate.

The first major figure to notice the relevance of ancient Stoic philosophy for modern psychotherapy was Albert Ellis.  In the late 1950s, Ellis began developing what later became known as Rational-Emotive Behaviour Therapy (REBT).  REBT is the main precursor of modern cognitive-behavioural therapy (CBT), currently the approach to psychological therapy with by far the strongest evidence-base for most clinical problems.  Ellis had read the Stoics as a youth.  He later trained in and practiced psychoanalytic therapy.  However, after becoming disillusioned with psychoanalytic theory and practice he started looking for a radically different approach, and remembered Stoicism.  Hence, Ellis explicitly stated that Stoicism was the main philosophical inspiration for REBT.  Stoicism arguably stands in the same relation to subsequent CBT approaches in general, although these are really quite a diverse cluster of different therapies, rather than a single homogenous approach.

Ellis’ approach placed considerable emphasis on the systematic and vigorous verbal disputation of irrational beliefs – its characteristic feature.  However, he used to provide clients with a quotation from Epictetus to illustrate his basic premise that our beliefs are at the root of emotional disturbance: “It is not the things themselves that disturb people but their judgements about those things” (Enchiridion, 5).  This quotation highlights a basic assumption shared by all cognitive-behavioural therapies: that we should begin by separating our thoughts from external events.  Ellis and Beck (the founder of “cognitive therapy”) both saw this as an important therapeutic insight but mainly because it was a necessary precursor to the use of disputation techniques.  Typically, for example, REBT or CBT practitioners would ask their clients to evaluate the “pros and cons” of an irrational belief, or the evidence “for and against it”, and to identify alternative rational beliefs to replace it with.  This, combined with “behavioural experiments” designed to test out and challenge irrational beliefs in practice, form the bulk of what happens in most modern CBT sessions.

However, although the Stoics do appear to have sometimes challenged specific beliefs in ways that loosely resemble this, it was perhaps not their dominant or characteristic approach.  REBT and CBT might encourage clients to challenge underlying (“core”) irrational beliefs such as “I am worthless” or “Other people must like me otherwise it’s awful!”  When philosophically evaluating beliefs, Stoics tended to focus on defending underlying precepts of an even more  general nature from which individual judgements are derived, such as “the only good is moral good”, considering the possible criticisms, or arguments against these positions, and those in favour of them.  Whereas CBT and REBT often target “underlying” value judgements, Stoic disputation might be described as more “philosophical” or “meta-ethical” as it tends to concern the very nature of “the good” itself.  (And it may be closer to what modern researchers term disputation of “metacognitive” beliefs, beliefs about beliefs or cognitions about cognition.) The Stoics do appear to have challenged their judgements about specific situations but the focus in their writings is typically more on defending their core philosophical dogmas.  Moreover, when Stoics do examine particular situations they appear to place more emphasis on constructing  a positive mental representation of how the Sage might act, or what virtues Nature has granted that allow them to rise above adversity.  CBT places more emphasis on the identification and direct disputation of negative or irrational beliefs.

Since the 1990s, different researchers have introduced alternative approaches to CBT that are collectively known as the “third-wave” movement.  (The first wave was behaviour therapy in the 1950s and 1960s, the second the rise of cognitive therapy in the 1970s and 1980s.)  Although there are significant differences between these new forms of CBT, they all tend to place less emphasis on direct verbal disputation of beliefs and more on the initial step of gaining “cognitive distance” (follow link for a detailed article on this concept).  Beck defined “distancing” in cognitive therapy as a “metacognitive” process, a shift to a level of awareness involving “thinking about thinking”, which he defined succinctly as follows:

“Distancing” refers to the ability to view one’s own thoughts (or beliefs) as constructions of “reality” rather than as reality itself. (Alford & Beck, 1997, p. 142)

In CBT, clients are usually “socialised” or introduced to this notion through the use of simple diagrams or metaphors.  For example, they may be taught that when thoughts distort our perception of events it’s like we’re wearing coloured spectacles.  When we gain cognitive distance from our own thoughts, it’s as though we’re taking off the spectacles and looking at them, rather than looking through them.  A similar “distancing” mechanism has been seen as integral to mindfulness meditation practices which have been found effective in the treatment of depression, and were therefore integrated with some forms of CBT.  Therefore, the third-wave approaches are often described collectively as the new “mindfulness and acceptance-based” approaches.  For example, one of the most prominent of these, Acceptance and Commitment Therapy (ACT), was originally called “comprehensive distancing” because it explicitly aimed to test the hypothesis that the initial “cognitive distancing” strategy in conventional CBT was much more important than had previously been assumed.

Unlike REBT and Beck’s cognitive therapy, these recent forms of therapy do not explicitly claim to be influenced by Stoic philosophy.  However, perhaps by chance, they may have many similarities with aspects of Stoicism that were overlooked by the founders of CBT.  In particular, it might be argued that Stoicism itself placed more emphasis on a something akin to “cognitive distancing” than upon direct disputation of beliefs.  This may have been somewhat overlooked by scholars because “distancing” is a more subtle and elusive concept than disputation.  For that reason, sometimes it is difficult to tell if the Stoics are genuinely referring to the same mechanism, as this often turns on subtleties of translation and interpretation.

One of the passages that stands out most in this regard occurs right at the start of the Enchiridion of Epictetus, where he writes:

Train yourself, therefore, at the very outset to say to every harsh impression: “You are merely an impression [phantasia] and not at all what you appear to be [phainomenon].” (Enchiridion, 1)

Alternatively, perhaps more literally: “You are an appearance and not in any way the thing appearing” – you are merely the subjective impression and not the thing in-itself.

Epictetus, as is often the case, appears to be literally instructing his students to repeat this phrase to themselves as part of a general-purpose psychological strategy for managing disturbing thoughts or impressions.   The fact that this occurs in the first passage of the Enchiridion may also signal its importance.   It’s presented, as in cognitive therapy, as a prelude to other strategies, which involve “testing” the impression by applying the core precepts of Stoicism to it.  At this point, cognitive therapy might involve weighing up the evidence for and against the impression (or “automatic thought”), or identifying the types of distortion it contains, such as “over-generalisation” or “black and white thinking”, etc.  However, Epictetus says the most important response a Stoic can make is to question whether the impression has to do with things under our control or not.  If it refers to something external, the student is to say to it: “It is nothing to me.”  That is, this is completely indifferent with regard to happiness and the good life, the chief goal of Stoicism.  The Stoics appear to have realised, as modern CBT does, that any form of re-evaluation or disputation is impossible unless the initial step of gaining “psychological distance” takes place first.  I have to be able to view my judgements as hypothesis (merely impressions) rather than as facts (confusing them with the things they claim to represent), before I can begin to question them as such.

In relation to this, Epictetus also refers many times to the strategy of avoiding “being carried away” (sunarpasthêis) by impressions in general, and not letting them “seize the mind” prematurely.  He specifically refers to impressions that attribute good or bad to indifferent things, such as pleasure, other people’s happiness, insulting behaviour, or fearful prophecies, etc.

When you get an impression of some pleasure, guard yourself, as with impressions in general, against being carried away by it; nay, let the matter wait upon your leisure, and give yourself a little delay. (Enchiridion, 34)

And so make it your primary endeavour not to be carried away by the impression; for if once you gain time and delay, you will more easily become master of yourself. (Enchiridion, 20)

This delaying tactic was well-known in antiquity and can perhaps be traced to the early Pythagoreans.  It resembles time-out or postponement strategies used in modern CBT, which require cognitive distance from an automatic thought, and the ability to defer thinking any more about it or acting upon it until later.  Another reason this works well is clearly due to the fact that emotional disturbances (“passions”) tend to come and go naturally and so returning to a thought at a later time, in a different “frame of mind”, generally makes it easier to evaluate it more objectively.

Beck’s cognitive therapy writings only discuss “cognitive distancing” very briefly, although he does mention about half-a-dozen practical strategies, which are taught to clients in the initial stage of therapy.  For example:

  1. Writing down negative automatic thoughts on a daily thought record, particularly fleeting automatic thoughts that might normally go unnoticed or get conflated with feelings
  2. Writing thoughts on a blackboard and literally viewing them from a distance, as something objective and “over there”, by patiently describing the colour, size, and style of the writing, etc.
  3. Viewing thoughts as inferences or hypotheses instead of facts, distinguishing between “I believe” and “I know”, discriminating carefully between thoughts and facts
  4. Referring to your thoughts and feelings in the third-person (“Bill is having anxious feelings, he’s thinking that people are criticising him…”)
  5. Using a counter to keep a tally of specific types of automatic thoughts, seeing them as habitual and repetitive, as just a meaningless side-effect of previous experience rather than something important and meaningful that deserves to be taken seriously
  6. Self-observation, being aware of your own awareness, noticing how you observe your thoughts, maintaining a sense of yourself as conscious observer, separate from the contents of your stream of consciousness
  7. Shifting perspectives and imagining being in the shoes of other people, who might disagree with your beliefs and view things differently, adopting a different perspective on things and identifying a range of alternative views, among which your current thought is just one of many

ACT and other third-wave therapies have added more techniques to this list and refined the existing ones.  In particular, they’ve introduced the use of mindfulness meditation techniques, derived from Buddhism, which are mean to train clients to develop greater detachment or psychological distance from their thoughts.  Beck himself never mentioned the use of meditation in this way, although it may seem an obvious adjunct to the techniques described above.

Moreover, a brief survey of the Stoic literature suggests that most of the psychological techniques employed can be seen as relating more to the mechanism of “distancing” than “disputation”.  For example, in the Enchiridion, Epictetus instructs students of Stoicism to do the following:

  1. We should continually maintain attention (prosochê) to the leading faculty of the mind (hêgemonikon), watching our judgements as they happen; as if watching our steps, cautious of stepping on a sharp object, or as if looking out for an enemy in hiding
  2. When upset, we should always remind ourselves that it is our judgment that harms us and not the external thing itself, and we should guard against being “swept away” by upsetting external impressions
  3. When something appears to be upsetting, you should imagine the same thing befalling someone else, so that you can judge it from a distance
  4. We should abandon value judgements and stick instead to a bare description of the facts of a situation, which forces us to see our value judgements as something we’re imposing on events rather than an intrinsic characteristic of external events themselves
  5. We should remind ourselves how the wise man would judge the same thing differently because noting that different people view things differently helps us to distinguish our thoughts from external facts.  Epictetus’ favoured example: Death cannot be intrinsically evil otherwise Socrates would have judged it to be so.
  6. We should postpone responding to impulses associated with powerful impressions until later, something which forces us to adopt a more detached perspective on them – modern therapists call this taking a “time-out” or simply “postponement”

These might be described as brief “shifts in perspective” rather than stepwise methods of disputation.  They are perhaps more experiential than verbal.  There’s no need to evaluate the evidence for these judgements, the Stoic simply reminds himself that they are judgements, peeling them away from the surface of reality, as it were, and viewing them as events within his own mind.  The Stoics referred to this process as “withholding assent” from initial impressions that mistakenly ascribe intrinsic value to indifferent things.  They assumed that impressions are outside of our control, being triggered by external events, like the “automatic thoughts” of cognitive therapy.  However, we do control what happens next: whether we accept the impression as reality or not, by giving our “assent” and saying “yes” to it.  Interestingly, the Stoics don’t seem to refer to saying “no” or exercising “dissent” toward impressions, merely suspending assent appears to be sufficient, at least at first.  Shortly after, attention may be shifted on to alternatives to the initial impression, such as “What would the Sage do?”

Some researchers, most notably the founders of ACT, have argued that verbal disputation techniques may interfere with psychological distance (which they call “cognitive defusion”).  The best way to illustrate this is perhaps by considering the example of Buddhist-style mindfulness meditation.  While meditating, if a distracting thought crosses the mind, mindfulness practitioners are taught to view it with detachment and resist the urge to respond to it by analysing its meaning or engaging in an internal dialogue about it.  They might view it as if it were like a cloud passing across the sky and “let it go”.  Engaging with the thought can simply make it more prominent, even if someone is attempting to challenge or dispute it.  One can easily be swept along with the thought this way and lose psychological distance from it.  The relative brevity of Stoic techniques arguably lends itself to maintaining psychological distance from upsetting impressions.  That could be lost again, though, if you “get into a debate with yourself” about the truth or falsehood of certain thoughts.  There’s a considerable body of modern research showing that attempts to suppress or distract oneself from distressing thoughts tend to be counter-productive.  Gaining psychological distance neatly circumvents this problem because it means neither assenting to (“buying into”) a thought nor trying to eliminate it, but rather viewing it from a detached perspective.  Rather than “I must not have this thought”, someone with psychological distance from their thoughts might say: “It’s okay to have this thought cross my mind but it’s just a thought, I don’t need to dwell on it or take it too seriously.”  There appear to be some references in the Stoic literature to suppressing automatic thoughts or feelings, though, which would be considered unhealthy and problematic from the perspective of modern research on psychotherapy.  However, the dubious strategies of thought-suppression or distraction do not seem to be an important or necessary part of Stoic therapeutics, and could easily be replaced with more consistent emphasis on “cognitive distancing” or merely withholding assent.

Ancient Healthcare and Modern Wellbeing Blog

Ancient Healthcare & Modern Wellbeing

“After reading a passage in which Marcus advocates this approach to himself, Patrick played a pre-recorded ‘View from Above’ meditation. The text for this meditation was adapted slightly from D. Robertson’s The Philosophy of Cognitive Behavioural Therapy (CBT): Stoic Philosophy as Rational and Cognitive Psychotherapy. […] This visualization was well-received and followed by lively discussion.”

The ancient healthcare and modern wellbeing blog contains an article describing the use of the View from Above meditation, derived from Stoicism.

Review in The Journal of Value Inquiry

The Philosophy of Cognitive-Behavioural Therapy (CBT)

Review in The Journal of Value Inquiry

The Philosophy of CBT CoverA very detailed and favourable review of The Philosophy of CBT has been published in The Journal of Value Inquiry by Dr. William Ferraiolo, a lecturer in the philosophy department at Delta College in San Joaquin, California.  Dr. Ferraiolo writes,

It is high time that some member of the community of contemporary therapists, so many of whom deploy one or more of the many permutations of cognitive behavioral therapy (CBT) to help manage their patients’ psychological dysfunction, paid proper obeisance to the ancient architects upon whose work so much modern therapeutic theory and practice are built. […] Fortunately, Donald Robertson undertakes precisely this task of uncovering and acknowledging the Stoic taproot of popular modes of contemporary therapy and counsel in his recent and admirable book, The Philosophy of Cognitive-Behavioural Therapy (CBT): Stoic Philosophy as Rational and Cognitive Psychotherapy.

He adds,

This down payment on the practicing therapist’s debt of gratitude to the ancient Stoics is a very welcome addition to both the academic’s and the practitioner’s library.  It ought to be required reading for students of Hellenistic philosophy, psychotherapists, and anyone undertaking an exploration of the human condition, or efforts to deal with challenges endemic to it, or both.

He concludes, after an overview and discussion of the contents,

For anyone interested in Hellenistic philosophy, Stoicism in particular, or in contemporary talk therapy and its foundations, The Philosophy of Cognitive-Behavioural Therapy (CBT): Stoic Philosophy as Rational and Cognitive Psychotherapy is an invaluable resource.  Philosophers, psychologists, therapists, counselors, and all others who hope to cultivate equanimity through rational self-governance are certain to benefit from Donald Robertson’s exploration of Stoicism as a wellspring of indispensable therapeutic wisdom.  Reading Robertson’s book should, itself, be considered a form of “bibliotherapy” and an effort of which the ancient Stoic masters would, no doubt, approve.